Effect of monopolar radiofrequency energy on pacemaker function

Area of Science:

• Electrophysiology
• Medical Device Engineering
• Surgical Safety

Background:

• Pacemaker inhibition by electrosurgical devices is a clinical concern.
• Monopolar and bipolar instruments pose varying risks to pacemaker function.

Purpose of the Study:

• Quantify clinical parameters affecting pacemaker inhibition by monopolar instruments.
• Identify settings and configurations that minimize pacemaker inhibition.

Main Methods:

• Utilized a pig model with a transvenous ventricular lead pacemaker.
• Measured pacemaker inhibition by counting dropped beats during monopolar activation.
• Varied generator power, mode, electrode distance, and dispersive electrode location.

Main Results:

• Decreased generator power (60W to 30W) reduced dropped beats (p=0.045).
• Cut mode showed fewer dropped beats than coagulation mode at 30W (p=0.015).
• Dispersive electrode placement away from the pacemaker/leads significantly reduced inhibition (p<0.001).

Conclusions:

• Lowering generator power minimizes pacemaker inhibition.
• Using cut mode instead of coagulation mode is safer for pacemaker patients.
• Strategic dispersive electrode placement is critical to prevent pacemaker inhibition.